The group admitted that low-carb can help diabetics lose weight but still ignores sugar-restriction as a treatment for diabetes

Feb 28, 2008

The American Diabetes Association took a slow step out of the nutritional dark ages last month by recognizing low-carb diets as an effective, short-term weight loss tool in their 2008 Clinical Practice Recommendations. The recommendations, which are used by doctors to treat diabetes patients, and by insurance companies as a standard for care, come after intense criticism from doctors (and our own editors) over the ADA's lack of acceptance of low-carb diets.

In the guidelines, the ADA states that low-carb diets appear as effective as the low-fat diets they've been supporting for years. What the ADA sees as the bigger picture is the evidence showing that a diet's make-up is less important than the person sticking to it, says Larry C. Deeb, M.D., past president of the ADA.

"In terms of glucose control, the new recommendations do not recommend against carbohydrate restriction for people with diabetes," explains Deeb. "And there continues to be strong evidence for fat and calorie restriction in diabetes prevention, and for controlling type 2 diabetes. The ADA's Professional Practice Committee will continue to look at the evidence regarding diet composition as it emerges."

That's a good start, but misses the point, counters Eric Westman, M.D., director of the Lifestyle Medicine Clinic at Duke University. "The guidelines don't address the basic understanding that carbohydrates are the main factors in the diet that raise blood glucose."

"Apparently years of clinical experience of using carbohydrate-restricted diets is not regarded as 'evidence,'" says Westman. "Carbohydrate-restricted diets are often even more effective, than medication therapy for type 2 diabetes. When obesity is present, carbohydrate-restricted diets have the advantage over medication because most people then lose weight, which then improves insulin resistance."

While the ADA's nod to low-carb diets may be small, it's still important. "It gives physicians permission or cover if they want to use carbohydrate-restricted diets to treat problems linked to the need for weight loss," says Mary Vernon, M.D., who's been prescribing diabetes patients with a low-carb lifestyle for years.

"The insurance companies often won't pay for treatments that aren't considered a 'standard of care.' And recommendations from large national organizations like the ADA are used to determine the standards."

It's essential to recognize that low-carb diets do more than lower weight, says Vernon. "The most common medical diagnoses today are all related to deranged blood sugar and insulin levels." That includes hypertension, arteriosclerosis and coronary artery disease, stroke, blocked arteries and even cases of elevated cholesterol and triglycerides.

"A glucose and insulin problem is the cause of the other problems," adds Vernon. "That is why the ADA is missing the point. Yes, carb restriction is very effective for weight loss. It is even more effective at generating whole body health."

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